Christa Pike survived her scheduled execution on September 30 in Tennessee after two doses of the sedative pentobarbital were administered without causing death, raising questions about the administration of the drug. Pentobarbital, commonly used in lethal injections across more than a dozen U.S. states and by the federal government, typically induces a coma and death by entering the bloodstream through an intravenous line. However, Pike’s attorneys and death penalty experts suggest the drug may not have entered her veins properly, potentially due to missed veins or improper insertion that delivered the drug into surrounding tissue rather than directly into the bloodstream. This points to human error as the likely cause of the failed execution.

Pentobarbital is a barbiturate used in animal euthanasia, assisted suicides, and in medical settings for sedation and seizure control at lower doses. In executions, it is administered intravenously under protocols that vary by state. Ohio was the first state to use pentobarbital alone in executions, starting in 2011. Since then, 14 states, including Arizona, Kentucky, Missouri, Oklahoma, Texas, and the federal government, have adopted it as the primary or sole execution drug.

The botched Tennessee execution follows concerns about the qualifications and involvement of medical professionals in death penalty procedures. The execution was overseen by Dr. Mark Fowler, who has been publicly identified as the physician involved in a previous failed execution in Tennessee earlier this year. During that attempt, the effort was abandoned after more than an hour because Fowler was unable to establish the required central intravenous line and a second IV line specified by state protocol. Family members of that inmate have alleged that he suffered serious health complications, including paralysis, during the ordeal. Fowler, who testified that he has not placed a central line in at least 13 years and currently holds no hospital privileges, defended his participation in executions as a means to reduce suffering.

Tennessee officials have not responded publicly to inquiries about Fowler’s involvement in executions or efforts to prevent further failures. Fowler successfully conducted a lethal injection in Tennessee in August prior to Pike’s execution attempt.

Pike’s attorneys had raised concerns nearly a year in advance about her medical condition, including thrombocytosis and unusually small veins, which they argued could complicate the administration of lethal drugs. These concerns were dismissed by the state and upheld by Tennessee courts, clearing the way for her execution in September.

The use of pentobarbital in executions has faced ongoing legal challenges. Opponents argue that the drug can cause pulmonary edema, leading to sensations of drowning and extreme pain. The U.S. Supreme Court has twice ruled in favor of states’ use of pentobarbital and other drugs in executions, citing their prevalence and procedural safeguards, while dissenting justices expressed concerns over the potential for severe pain and the lack of meaningful judicial review.

Following the failure to execute Pike, her legal team is actively seeking to prevent a second attempt. An investigation into the circumstances of the botched injection is ongoing as the debate over the use of pentobarbital and the qualifications of personnel involved in executions continues nationwide.